Anesthesia Coding Alert

Check our tips for easy processing Coders who focus solely on anesthesia claims occasionally need to get preauthorization for procedures - but pain management coders don't get off as easy and are required to obtain preauthorization almost every day. If you continually fight the preauthorization battle, fill your arsenal with some tried-and-true tips provided by pain management coding experts. Clarify Your Terminology When you talk about these cases in your office, how does everyone refer to them? Are you trying to "pre-authorize" the procedure or "precertify" it? An even better question might be: Does it really matter what you call it as long as you know what you're doing?

Some groups use the terms "preauthorization" and "precertification" interchangeably; others don't. Groups that distinguish between the terms usually say that obtaining precertification means the carrier says, "Yes, you can perform that procedure for that diagnosis." Pre-authorization means the carrier says, "Yes, you will be paid for performing the procedure."

If you look at the terms in this light, preauthorization is like a guarantee for payment, whereas precertification might not be (instead, precertification validates the medical necessity of a test, procedure, surgery or inpatient hospital stay). When talking with a carrier, try to avoid confusion by being sure everyone uses the terms in the same manner.

Realize that it can still be difficult to get paid for some procedures, even with preauthorization. However, many coders say that obtaining precertification or pre-authorization is important and generally gives you some leeway for payment. Check Carrier Guidelines Most injection procedures and more detailed procedures such as spinal cord stimulator or pain pump placement must be preauthorized, says Tammy Reed, CPC, anesthesia department billing manager for Oklahoma University Health Science Center in Oklahoma City. Codes to watch for include:

  Neurostimulator codes 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) and 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver)

  Pain pump codes 62360 (Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir), 62361 (...non-programmable pump) and 62362 (... programmable pump, including preparation of pump, with or without programming)

  Lumbar epidural steroid injection code 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]). "Some carriers don't require precertification but do have medical-necessity issues to establish," Reed says. "We always contact the carrier to see if precertification is required or if there is a medical-necessity issue we should investigate first."

Another good question to ask is whether the carrier covers the procedure when it is conducted in an ambulatory surgery [...]